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Chapter 5

A Decade of Progress - Contents

Education and Training

Instruction enlarges the powers of the mind.-HORACE.

The Surgeon General, acutely aware of the increasing role of specialization and teamwork in medical science, stressed consistently the need for creating an Army Medical Department team of highly trained medical and paramedical specialists. Through training he hoped to integrate concepts of teamwork and specialization into the entire spectrum of Army medical service, from the infantryman trained to give emergency first aid to his buddy on the nuclear battlefield, through the line commander responsible for the health of his troops, to the ultimate cooperation of surgical teams working over a soldier with multiple wounds.

From the beginning of General Heaton's tenure as The Surgeon General through the Army's combat test in Vietnam, training programs in the Medical Department were designed to harness the full power of modern medical specialization and teamwork to provide America's soldiers with the highest quality of medical care.

PROFESSIONAL TRAINING

The Army Residency Program

As a result of experience in World War II, when the small number of specialists in critical areas available from civilian practice forced the Medical Department to institute crash programs to train the specialists required for global war, the postwar Medical Department insti-


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tuted residency programs in an effort to create its own supply of specialists. The residency program in effect at the time of General Heaton's appointment received his enthusiastic support. As he repeatedly told a variety of audiences, "I consider the residency training program the very heart of our recruitment program for the regular corps." During his tenure, the program continued to grow, expanding from a total of 330 Army and 48 Air Force residents enrolled for training at Army teaching hospitals in fiscal year 1958 to a total of 655 Army and 38 Air Force residents in fiscal year 1968. About half of this expansion reflected increases in the size of the residency program, and the remainder resulted from the expansion of Army teaching facilities which allowed residents previously trained at civilian institutions to be absorbed into the military program. Between fiscal years 1958 and 1968, the number of Army residents who had to be trained at nonmilitary facilities declined from 104 to 14. Most of those remaining in civilian residencies were in specialties such as public health and children's orthopedics, areas in which training was not available within the Army in broad enough scope to qualify residents for board certification.

Plans for the expansion of military training facilities included a program for the affiliation of class I and class II hospitals. During 1960, The Surgeon General prepared a pilot program calling for an affiliation between 10 class I and four class II hospitals in general surgery. Initially, the program was to begin in September 1960, but was later deferred until 1961 to allow general surgery residents assigned to class I hospitals more time to become familiar with the procedures and methodology of these installations. During 1961, plans for a large-scale pilot program were discontinued, but in the ensuing years an increasing number of class I hospitals selectively entered programs of affiliation with class II hospitals. The expansion of facilities for residency was evidenced by the increase from 24 residency training programs conducted at eight Army hospitals in 1959,


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to 28 programs at 17 hospitals, including seven class II and 10 class I installations. Specialties either added or reinstated during the period included care and treatment of laboratory animals, forensic pathology, and physical medicine.

The Army Internship Program

Introduced into the Medical Department program of professional training at about the same time as the Army residency program, the Army internship program continued throughout the decade to provide more and better professional training for graduates of medical schools approved by the American Medical Association, who wished to serve in the Army Medical Department. Under this program, selected graduates were commissioned in the Medical Corps Reserve, and ordered to active duty to complete a 12-month rotating internship. The program, designed to meet requirements published by the Council on Medical Education and Hospitals of the American Medical Association, included rotating training in internal medicine, surgery, obstetrics and gynecology, and pediatrics. A 2-month elective was also included in the program, and participants were not required to continue in military medicine beyond their normal obligations.

General Heaton backed this program vigorously, and the years from 1959 to 1969 were marked by continuous progress. The number of spaces available for interns increased from 178 in fiscal year 1959 to 198 in fiscal year 1965, the last year in which the number of spaces authorized increased. During 1964 and 1965, internships at class I hospitals were discontinued, making training at large general hospitals available to all participating in the expanding program. Beginning in May 1968, the Medical Department was authorized to convert 32 of its spaces into straight internships to allow participants to specialize early in their careers.

As a result of these developments, an increasing number of young physicians entered Army residency programs and continued in military practice. Developments


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in the Army's program of dental internship were similarly progressive, and the high level of interest evoked among dental students made it possible to select students of the highest caliber.

The Army Fellowship Training Program

During the past decade, fellowship training was consistently available in the Medical Department for the purpose of providing officers with training in specialized fields. These fellowships could be used to broaden an individual's general knowledge or to prepare him for an assignment as an investigator or teacher. The greatest number of fellowships were offered by the Armed Forces Institute of Pathology, which provided pathology training in several fields. A lesser number were offered by the Walter Reed Army Institute of Research, which provided training in various aspects of hematology, biologics, and immunohematology. Fellowships were also available at the Surgical Research Unit, Brooke Army Medical Center, in surgery, internal medicine, and pathology. Still other fellowships were available for qualified officers at certain foreign medical centers, and in other specialties, upon request. During 1962, personnel policies were amended to require individuals in the fellowship program, who had originally participated free of obligation, to pay back their training by serving an additional year for each year on fellowship, thus ensuring the Army Medical Department of their continuing service.

Military Postgraduate Courses

To supplement formal training provided by the residency, internship, and fellowship programs, the Army Medical Department provided a continuously growing program of postgraduate education, consisting of long and short courses ranging from 1 day to more than 2 years in length, at Army hospitals, laboratories, and schools, as well as civilian institutions. Short courses (programs less than 20 weeks in length) were attended


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by officers on temporary duty status, while longer courses required a permanent change of station. As early as fiscal year 1960, more than 1,300 officers of various Medical Department corps participated in one or more of 40 different types of postgraduate professional short courses designed to keep them abreast of developments in their fields of specialization. By fiscal year 1966, this number had grown to a total of 1,776 Medical Department officers and 3,827 others attending 87 short courses. In subsequent years, numbers decreased slightly in response to personnel pressures resulting from South Vietnam. Many of the courses conducted at Army medical facilities were of primary interest to physicians, but a number of courses, such as Management of Mass Casualties, and Principles of Medical Operations in Nuclear Warfare, produced widespread interest in both the civilian community and the Military Establishment. Such interest was demonstrated by the growing number of "others"-a wide range of civilian and military personnel-who voluntarily attended Medical Department short courses.

In addition to short courses offered by the Army Medical Department, an increasing number of officers received valuable training through other Federal agencies. Between fiscal years, 1966 and 1968 alone, the number of officers attending courses offered by the Department of the Navy and the Air Force, the Department of Health, Education, and Welfare, the Civil Service Commission, the Defense Atomic Support Agency of the Department of Defense, and other agencies, increased 46 percent to a total of 430. Among the courses which resulted in increased interest from the Army's specialized medicomilitary team were the Defense Atomic Support Agency's offerings in the medical aspects of nuclear warfare, the Department of Defense Armed Forces Management Course, and the Chemical, Biological, Radiological Weapons Orientation Course. As the threat of brush-fire wars continued to grow in the early l960's, increasing numbers of Medical Department officers re-


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ceived counterinsurgency training. As early as fiscal year 1962, 23 Medical Department officers were in training in this program at the U.S. Army Civil Affairs School, Fort Gordon, Ga., and in 1964, an unscheduled seminar on the medical aspects of counterinsurgency was prepared for Army Medical Department officers and medical personnel from other military and civilian services. During fiscal year 1964, the number of Medical Corps officers who completed airborne training increased from 24 to 45.

The complexity and interdependency of long- and short-course training in building a team of specialized medical and paramedical military officers was graphically illustrated by the growth of the Army's program in aviation-oriented medical service. The apex of this program was the Army Areospace Medicine Residency, a 3-year program in which the trainee pursued a master of science degree in public health, or its equivalent, at a civilian institution, attended a 1-year advanced course at the U.S. Air Force School of Aviation Medicine at Randolph Air Force Base, Tex., and spent a final year at a U.S. Air Force installation in flight status, performing duties in aviation medicine. The growth of this program reflected the Army Medical Department's response to an increasing need for physicians qualified to handle the special problems of aviation and aerospace medicine. In addition to career-oriented Medical Corps officers trained through aerospace residency, the army required a growing number of physicians trained as aviation medicine officers. Officers meeting the physical standards for this training were selected from Medical Corps officers on active duty, attended courses ranging from 9 to 22 weeks at the Navy and Air Force schools of aviation medicine, and completed 2 weeks of training at the U.S. Army Aviation School at Fort Rucker, Ala. By fiscal year 1966, the number attending the course had grown to 68 per year. During the same year, an aviation orientation course for senior Medical Department officers was established at this school, emphasizing air mobility and the


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expanding utilization of Army aviation units to support ground forces. A total of 16 students attended during the first year of the course. Attendance at the Aviation Crash Injury Course, a short course conducted by another Federal agency, also increased. Constantly growing numbers of paramedical military personnel received training as helicopter pilots, and the number who received training as fixed-wing pilots declined throughout the period. Between fiscal years 1962 and 1967 alone, the quota of Medical Department personnel to receive training as rotary-wing aviators increased from seven to 64. To round out the program of training for an aviation-oriented Army Medical Department, a new course, the 3-week Essential Medical Training for Aviators Course, was approved in April 1965, to provide Medical Department pilots with a working knowledge of the problems encountered in aeromedical evacuation of the sick and wounded, and the emergency techniques applicable to evacuation. Thus, a team was forged of the aerospace medical specialists, the pilot-surgeon's assistant, and specialists in aviation medicine and support techniques, illustrating the interdependency of specialists in modern Army medicine.

The decade was also marked by a significant increase in the number of senior officers who received advanced military training. In 1959, the number of Army Medical Department officers attending military staff colleges was small, but adequate for current requirements. Early in 1961, requests for additional quotas were forwarded to the Department of Defense, because of the Medical Department's recognition that, by 1965, the loss of officers qualified for staff positions by experience in World War II would require an increased number of trained senior officers. By fiscal year 1964, the number of officers enrolled in Army and Joint Service Colleges had increased to four attending the Army War College, 20 attending the regular course at the Command and General Staff College and 18 in the shorter associate course, two attending the Industrial College of the Armed Forces, and


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four attending the Armed Forces Staff College. In many instances, this represented a doubling of previous enrollments. Because of demands placed on the Medical Department by the conflict in Vietnam, enrollments in senior service colleges declined slightly in subsequent years, but the total remained well above that reached in the previous decade.

Postgraduate Courses at Civilian Institutions

The National Defense Act of 1920, as amended, permitted the Army Medical Department to send officers to civilian schools to receive specialized training not available in the military school system. Courses of less than 20 weeks were considered short courses and, until 1959, provided the bulk of professional training opportunities. In contrast, largely as a result of General Heaton's efforts, the decade was marked by an impressive expansion of long courses and programs leading to academic degrees designed to advance his concept of specialization and teamwork.

In absolute numbers, the increased degree of Medical Department participation in civilian education was impressive. From the fiscal year 1959 total of 361 officers enrolled in civilian schools-212 in short courses, 116 in long courses, and 33 in courses leading to an academic degree-the total enrolled in all of these categories had increased to 1,384 by fiscal year 1967. Even more impressive, however, was the marked upgrading of educational requirements and opportunities within the Medical Department. As early as 1959, The Surgeon General emphasized the importance of qualifying career officers for the master's degree, particularly in such fields as business administration, hospital administration, public health, bacteriology, biochemistry, periodontics, institutional management, and physical therapy. He recognized also the need for individuals with training through the doctorate in such fields as entomology, microbiology, radiobiology, social welfare, bacteriology, biochemistry, and hospital administration.


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A salient example of the continuous upgrading of requirements that marked the past decade was the change in the advanced course in radiobiology, sponsored by the Defense Atomic Support Agency, and originally held at Reed College, Portland, Oreg. Originally 6 months in length, encompassing 24 weeks of applied work at Federal agencies, the course was reorganized in 1960 to encompass 9 months of training leading to a master's degree. In the process of reorganization, it was transferred to the University of Rochester, Rochester, N.Y., which was authorized to award advanced degrees. In 1962, this course was supplemented by the establishment of a similar course at the University of North Carolina, Chapel Hill, North Carolina.

In addition to advanced training for members of the Medical Corps, educational opportunities were increasingly extended to the other corps of the Medical Department. In fiscal year 1961, The Surgeon General received authorization from the Department of the Army to increase the number of officers in the Degree Completion Program from 12 to 30, thereby allowing a larger number of Medical Service Corps, Army Nurse Corps, and Army Medical Specialist Corps officers to obtain a college education. In fiscal year 1962, two members of the Army Nurse Corps were working for the master's degree, and the following year, a Medical Service Corps officer seeking the doctorate in education was reported as the first Army Medical Department officer in the Degree Completion Program at this level. Other officers were increasingly reported as attending nonprofessional long courses in such areas as institutional management, packaging, personnel management, business administration, hospital administration, and comptrollership

By 1965, The Surgeon General's concept of specialization and teamwork through training became increasingly recognized by the Department of the Army, a recognition that was reflected by the authorization of greater discretionary power and approval of higher educational prerequisites for Medical Department personnel.


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In April 1965, The Surgeon General assumed responsibility for negotiating contracts for tuition and related fees with civilian institutions for Medical Department military personnel, giving him greater flexibility in meeting training requirements. The following year, the Army Education Requirements Board approved the validation of an additional 720 Medical Department positions, bringing the total number of validated positions to 2,064. Subsequent actions by that Board in 1967 and 1968 brought the total number of validated positions to 3,077, including 756 positions for Medical Department officers requiring graduate education, 642 at the master's level and 114 at the doctorate level.

On-The-Job Training

The last of the general categories of professional training available to Medical Department officers was "on-the-job training," conducted within Army medical facilities and designed to train officers in specialized fields in which adequate knowledge of a subject can be gained by working under close supervision. Predictably, training of this type declined as the educational requirements and opportunities increased. In fiscal year 1959, Medical Corps officers were engaged in programs in otorhinolaryngology, radiology, and psychiatry, but only 36 physicians participated as compared to 124 the previous year and 329 in fiscal year 1957. The same year, 42 graduates of the Medical Supply Officer Course were assigned to selected Army hospitals and medical depots for a 12-month period of training. Courses were also established for junior Army Nurse Corps officers to alleviate shortages of operating room, obstetric, and pediatric nurses. These new courses were 22 weeks in length. The following year, fiscal year 1960, only 15 Medical Corps officers were reported participating in on-the-job programs. A number of junior Medical Service Corps officers were assigned to hospitals in the continental United States for a year of training in personnel management and in the duties of comptrollers and re-


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gistrars. After 1960, as the availability of formal training programs grew, on-the-job programs ceased being discussed in The Surgeon General's annual report. Subsequently, the only personnel reported trained by these methods were nurse anesthetists. Undoubtedly, on-the-job training continued to fill the needs of hospital and unit commanders in many lesser specialties, but its removal from the annual report as a significant category of training signaled the growing reliance of the Medical Department on more formal methods.

SERVICE SCHOOL COURSES

Military Training

In applying the concept of specialized teamwork to the practice of military medicine, the common bond between the Army Medical Department's multitude of diverse specialties was provided by military training. Traditionally, this union had been forged in courses provided by the Medical Field Service School (founded in 1920 at Carlisle Barracks, Pa., and moved to Brooke Army Medical Center, Fort Sam Houston, Tex., in 1946) and the U.S. Army Medical Service Veterinary School Chicago, Ill., that grew out of programs in World War II. Programs at these facilities encompassed basic and advanced military training for elements of all corps and specialties in the Medical Department. By regulation, supervision of the military training of all Medical Department officers is a direct responsibility of The Surgeon General.

When General Heaton became The Surgeon General, the Medical Department offered a comprehensive program of service school courses. In fiscal year 1959, 15 special service school courses were conducted with spaces available not only to active-duty officers in the Army, but also to Navy, Air Force, Reserve, and National Guard officers, as well as to other Federal agencies, civilians,


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and foreign nationals. The total number of Medical Department participants in these courses was 1,916.

One of General Heaton's first acts as chief of the Medical Department was to protest the designation of the Medical Field Service School as the "Army Medical Service School." The name of the Medical Department's academic home had been changed as a result of a belief that the traditional designation was inaccurate because the school was not entirely restricted to field medical service. It was General Heaton's view, however, that the presence of a few purely professional and technical courses did not change the basic function of the school, and in a desire to stress the importance of field medicine and the function of the school in developing and promulgating doctrine on the principles and methods of field medical service, he pressed for a restoration of the traditional title. As a result of these efforts, the traditional and historical designation of "Medical Field Service School" was restored in December 1960 (fig. 10).

A second significant achievement was The Surgeon General's successful defense of his role as an independent training agency during the buildup years of 1965-66. On 23 June 1965, a board was appointed by the Department of the Army to determine the adequacy and propriety of the Army school system and the training of Army officers. This group, which came to be known as the Haines Board, after its president, Lieutenant General Ralph G. Haines, Jr., consisted of senior officers from the combat arms, technical services, and administrative services, and one civilian educator. In its final recommendations, the Haines Board concluded that most Army schools belonged under the command of the U.S. Continental Army Command, but that the Medical Field Service School should be continued under its traditional commander. After studying almost every facet of its operations, the Board concluded informally that the Medical Field Service School was one of the best-run


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FIGURE 10.-Medical Field Service School, Brooke Army Medical Center, Fort Sam Houston, Tex. (Armed Forces Institute of Pathology photograph.)


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schools it had seen and expressed the opinion that it should be left alone.

This opinion was reflected in the Board's final recommendations, which stated that The Surgeon General should retain command of, and be completely responsible for, the Medical Field Service School and the Army Medical Department Veterinary School. They noted that "the AMEDS [Army Medical Service] School system and courses * * * are today being operated effectively and efficiently under [The Surgeon General]. The [Continental Army Command] span of control, already overextended, would be stretched even more if * * * AMEDS schools were added to it. The massive size and complexity of the AMEDS system commands its retention under existing arrangements." This finding was the most important recommendation of the Haines Board in respect to the Medical Department. Other recommendations which affected the Medical Field Service School included the use of programmed instruction, television, teaching machines, and new methods in Army teaching. These recommendations brought many changes to the Medical Field Service School in the following years.

During the decade, many changes were made in the length and title of courses conducted by the Medical Department. Many of these changes were changes in name only, to renumber or alter titles to conform with Department of Army directives and systems. A few, however, represent historically significant innovations.

Among the significant trends in Medical Department military education were an increasing emphasis on providing special courses to meet the needs of its components and an increasing emphasis on advanced training for career officers. During General Heaton's first year in office, the general Army Medical Department Orientation Course was changed to the Army Medical Department Officer Basic Course, and restricted to medical, dental, and veterinary officers, and new courses were provided for members of other corps. The orientation


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course for Medical Service Corps officers was lengthened from 12 to 16 weeks and became the Medical Service Corps Basic Course. New Army Nurse Corps officers were provided with a separate 9-week basic course, and new Army Medical Specialist Corps officers were allowed to attend the first 4 weeks of that course. A 23-week course, Advanced Military Nursing, was established for career Army Nurse Corps officers, replacing an older course in administration, and quotas for the Army Medical Department Officer Advanced Course, a career course designed to prepare officers for further schooling, were expanded to make more officers eligible for advanced education programs. This pattern, in various guises, dominated the program of the Medical Field Service School throughout the decade. When the need arose, courses previously given as specialties through the postgraduate short-course program were given functional status and transferred to the service school program to provide large numbers of officers with special training. An example of this technique was the introduction of an 8-week course, Introduction to Environmental Health, to the special service school program to provide recently commissioned engineers and entomologists in the Medical Service Corps with a working knowledge of military environmental health service to enhance their effectiveness in preventive medicine, and the addition of a course in patient administration.

In addition to providing increasingly specialized military training, the Medical Field Service School was marked by rapidly increasing student loads. From a total number of 1,916 participants in fiscal year 1959, the student load increased from 4,010 officers in the last year before the South Vietnam buildup to 6,544 officers in fiscal year 1968. Providing training for this number of officers resulted in severe strain on the school's facilities, but basic training was provided for all new members of the Medical Department without a notable decline in the quality of its graduates.


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Training of Foreign Nationals

Among the responsibilities of the Medical Department throughout the last decade was the training of foreign nationals. This program, designed to increase the efficiency of foreign programs and enhance the prestige of the Army Medical Department and the United Stated abroad, encompassed school and observer training in such specialties as medicine, dentistry, nursing, and administration. Numbers involved in the program fluctuated heavily during the decade, ranging from as many as 400 to as few as 150, with no apparent trend.

Training Aids

During the closing years of the 1960's, the Army Medical Department made tremendous strides to keep itself abreast of modern developments in educational techniques and theories. In response to the recommendations of the Haines Board, and subsequent objectives announced by the Assistant Secretary of Defense (Manpower), steps were taken to utilize taped instruction, television, computers, and other devices to present training material to students at multiple locations. Early in 1967, plans were made and funds were programmed for the installation of an extensive closed-circuit instructional color television system at the Medical Field Service School. The system was designed to overcome the problem of shortages of instructors by increasing the number each instructor could reach through televised classes. Lectures were recorded for later use, and smaller systems were purchased for other Medical Department class II training activities, to provide a Medical Department-wide closed-circuit instructional television network. In June 1968, The Surgeon General announced that all class II facilities except Letterman General Hospital had been equipped with closed-circuit television, that a second system had been established at the Medical Field Service School, and that a video tape loan service with 52 programs had been established at the


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Armed Forces Institute of Pathology. A system for Letterman General Hospital was completed in June 1969.

During 1967, contracts were also awarded for the development of programmed instructional materials. A new and unconventional teaching method, programmed instruction required less direct participation by instructors, permitted precise definition of measurable learning objectives, and provided for logical, progressive arrangement of the small steps of the learning process requiring frequent responses from the student and producing feedback that enhances learning. A 2-week workshop was held on programmed techniques for representatives of Medical Department training facilities. In June 1968, The Surgeon General reported that six programmed texts, including 20 hours of instruction in medical terminology, introductory microbiology, physiology, and related subjects, were being distributed to participants in the Clinical Specialist Course and that other programmed texts were being developed for use in approximately 90 hours of instruction in resident courses at the Medical Field Service School.

In other developments, the Medical Department announced the purchase of several cartridge-type 8-mm. film projectors for use by students for remedial studying, and an 8-mm. kinescope which converted video tape to film so that students could use taped lectures in the cartridge projectors. A plan for utilizing computer support for classroom instruction and war games was also developed. Finally, the Medical Department joined in participating in Project Transition, which was designed to provide servicemen with marketable skills to ease their change from military to civilian life.

Training Guidance

In addition to providing training for members of the Medical Department, The Surgeon General continued to exercise his responsibility of providing training guidance in medical matters for the entire Army. These duties


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encompassed not only the routine review of training films and literature, and their replacement or revision, but also the formulation of new doctrines on problems confronting military planners. During the early 1960's, The Surgeon General placed increasing emphasis on Army-wide training in emergency medical care for survival on the nuclear battlefield. Through training circulars and regulations, new policies were established for training the individual soldier for battlefield survival, and officers and enlisted personnel in the management of mass casualties.

In March 1960, the latest Army Medical Department doctrines for response to nuclear disasters were tested at Fort Sam Houston, in Operation SURVIVAL, before some of the Nation's leading civilian medical educators and top-ranking members of the military services. One of the purposes of Operation SURVIVAL was to underline the necessity of emergency medical care training for Army troops to ensure their survival on the nuclear battlefield. In demonstrating the techniques of emergency medical care and their relationship to various levels of division organization, three main problems were highlighted: (1) In the field, as in garrison, the initial care to casualties will frequently be self-aid or buddy-care, (2) the logistics burden imposed by mass casualty situations represents a serious drain on a division's manpower and equipment, and (3) a disparity exists between medical means and medical requirements within the infantry battle group. Subsequent maneuvers throughout the decade continued to demonstrate the problems of medical support to nonmedical military commanders.

ENLISTED TRAINING

At the beginning of the decade, responsibility for training all officer and enlisted personnel of the Medical Department was vested in The Surgeon General. After the reorganization of the Department of the Army in


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1962, however, command of all Army training centers, including the Medical Training Center, was consolidated under the U.S. Continental Army Command, dividing the responsibility for enlisted training between The Surgeon General and a second Army Command. As a Special Staff officer, and the director of a technical service, The Surgeon General retained his responsibilities for promulgating doctrine and controlling the technical content of instruction. Responsibility for the control of doctrine for basic aidmen was discharged through the command channels of the U.S. Continental Army Command, through the Fourth U.S. Army, to the U.S. Army Medical Training Center, Fort Sam Houston. Other duties included providing instruction in occupational specialties, advanced training in a number of specialties, and functional or refresher training. During General Heaton's tenure, these responsibilities were discharged through the Medical Field Service School, the Army Veterinary School, and selected Army hospitals.

After the reorganization of the Department of the Army in 1962, advanced individual training for both male and Women's Army Corps enlisted personnel became a direct responsibility of the U.S. Continental Army Command, with technical control exercised by The Surgeon General through command channels. Students came to the Army Medical Training Center after completing basic combat or Women's Army Corps basic enlisted training, where they participated in a 10-week Advanced Individual Training course (8 weeks for Wacs), leading to Medical Aidman, MOS 91A10. A 6-week modified basic training course, excluding combat training, was also conducted for conscientious objectors, as well as several short courses in instructional techniques and duties not related to patient care. Further training in medical duties fell under the direct control of The Surgeon General.

Training programs under the direct control of The Surgeon General spanned a broad range of courses and career patterns. Programs available to enlisted person-


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nel included special service schools and civilian institutions in military occupational specialty qualifications ranging from operating room technician to food inspector. During the decade, course offerings continuously changed to meet current and anticipated needs, as the Medical Department rose to the challenge of keeping abreast of changing medical and military requirements. It was a mark of the high caliber of enlisted training that the Medical Department's greatest single problem during the 1960's was in preventing the quantitative pressure of the South Vietnam buildup from eroding the quality of training for enlisted personnel. During fiscal year 1966 alone, the programmed enlisted training load of courses under the direct authority of The Surgeon General increased 34 percent, from 6,652 to 8,883, and the following year this load increased to 10,302. This onslaught of trainees was met by adding courses, double-shifting courses on some occasions, and an increasingly selective choice of instructor personnel. A part of this pressure was also relieved by use of the educational innovations discussed earlier. By 1968, with the peak of the buildup past, the Medical Department was able to report that it had met the challenge of expansion without evident loss of quality.